Ripples of Despair -  Shining a light on the impact of lives lost to alcohol, drugs, and suicide (2024)

When I said, well, actually my dad took his own life, I started to feel sorry for the people that asked that question because I could see their Persona change instantly. I could see they felt bad for asking the question or shocked. 

Death is a difficult topic to discuss, yet it's an inevitable part of life. This report highlights how death impacts those affected by alcohol, drugs and suicide, and how stigma can make grieving even harder for families. "Death literacy" refers to having the knowledge, skills and understanding to support others through dying, loss and bereavement. It's an important way for communities to offer compassion and care during life's most challenging moments.  

Barriers to end-of-life care for people with alcohol and drug issues 

People struggling with alcohol and drug disorders are less likely to access timely end-of-life care, missing the chance for a dignified and supported death (195). This group experiences what researchers call "structural vulnerability" - a lifetime of inequalities that follow them into death. Factors like poverty, trauma and stigma amplify this vulnerability, leaving their physical, emotional and social needs unmet (195,196).

 Unlike predictable disease trajectories like advanced cancer, conditions caused by drugs and alcohol often involve a more uncertain decline, making it harder for healthcare professionals to plan or initiate conversations about dying. Unfortunately, avoiding these conversations leaves individuals without the opportunity to prepare for the future or express their wishes for care. Terminal illnesses tied to drugs and alcohol also carry additional stigma. As a result, people with drug and alcohol issues often don't receive palliative care until their final days - if at all - missing out on the comfort and dignity of a well-planned death and the accompanying care (195,197).

Fear can also play a role. Research shows that some individuals delay seeking care, worried they'll be judged, denied pain relief, or required to abstain from substances before receiving help (198). For those facing multiple disadvantages, like homelessness or hunger, addressing basic needs often takes priority over health, leading to late-stage care that's often too little, too late (199).

The current system often fails these individuals. Unlike integrated cancer or palliative care services, those with illnesses caused by drugs or alcohol experience fragmented and inconsistent support. They are frequently passed between services without receiving the holistic care they need, leaving gaps in treatment and bereavement support for their families. 

The importance of 'end of life' literacy 

Death literacy helps people plan for, navigate and support others through dying, loss and caregiving. It includes understanding practicalities like wills and healthcare preferences, as well as emotional and social aspects of death and grief. When this literacy is lacking, people can feel unprepared and isolated, while families and friends may struggle to cope with the loss.  

When I spent time with Gateshead's addictions team, I heard how often they encountered death. While staff felt unprepared to talk about it, those with lived experience were much more open. Conversations about death seemed less of a taboo in this community.

Dr Elizabeth Woods, Consultant in Palliative Medicine 

Improving death literacy can empower individuals and communities to offer better support during end-of-life care. Open conversations about death, dying and grief can break taboos and dismantle stigma, creating safe spaces for closure with compassion. 

Compassionate cities: a model for better end-of-life care 

Compassionate cites aim to create environments where aging, dying and grieving are seen as natural parts of life, supported by the entire community. This model integrates education, awareness and practical support into everyday spaces like schools, workplaces and homes (200). Grief is often thought of only as an emotional reaction to loss. However, this narrow understanding ignores wider social consequences of loss, including anxiety, depression, loneliness, social isolation, stigma, rejection, missed work or school, and even suicides and sudden deaths which can follow on from experiences of dying.

Compassionate cities aim to acknowledge these social impacts and promote health and wellbeing through better support, information and prevention initiatives which might mitigate these challenges.

Plymouth and Birmingham, the first compassionate cities in England, have taken steps to improve end-of-life care for marginalised groups, including those with drug and alcohol addictions. Initiatives like training "end-of-life ambassadors" and hosting workshops for street pastors and addiction nurses have enabled these communities to offer better care and understanding. By normalising conversations about death, compassionate cities help to dismantle the stigma surrounding dying, loss and addiction-related deaths. These efforts not only improve care for individuals but also build stronger, more empathetic communities. 

Creating a compassionate gateshead  

Gateshead has the opportunity to embrace the compassionate cities approach (201), ensuring that everyone (regardless of their circumstances) has access to dignified end-of-life care. For people with illnesses related to drugs and alcohol, early conversations about planning for the worst while hoping for the best could make a significant difference. By improving death literacy and addressing the inequalities that shape end-of-life experiences through our services, charities and communities, Gateshead can become a place where every resident can live - and die - with dignity, compassion and support.